Postoperative Analgesia In Laparoscopic Cholecystectomy Research Articles

SEVOFLURANE REQUIREMENT TO ATTENUATE STRESS RESPONSE TO PNEUMOPERITONEUM AND POST-OPERATIVE ANALGESIA DURING LAPAROSCOPIC CHOLECYSTECTOMY: INTRATHECAL DEXMEDETOMIDINE VS. FENTANYL. A PROSPECTIVE RANDOMISED STUDY

Background and aims: Laparoscopic cholecystectomy is considered as the gold standard for cholelithiasis with better preservation of surgical anatomy, early recovery and post-operative analgesia but haemodynamic instability due to pneumo-peritoneum is a concern. This study was contemplated to assess the effect of intrathecal dexmedetomidine or fentanyl on end-tidal inhalation agent concentration requirement as an indirect measure of haemodynamic stress response during the creation of pneumo-peritoneum and on post-operative analgesia. Methods: This prospective, randomized, comparative study was conducted in 75 ASA I and II patients with three groups of 25 each. The patients in group-1 received 10µg of intrathecal dexmedetomidine, group-2 50µg fentanyl and group-3 equal volume of normal saline before administration of general anesthesia. We assessed the vital parameters and end-tidal concentration of sevourane requirement before and 10minutes after creation and immediately after deation of pneumo-peritoneum. Post-operative pain scores were measured using Visual analogue scale(VAS) for 24hrs and rescue analgesia was 0.5µg/kg fentanyl in the immediate post-operative period and paracetamol 15mg/kg if the score was ≥4 in the post-operative period. Results: Demographic data were comparable in all the groups. Systolic blood pressure before onset of pneumo-peritoneum(P=0.03),endtidal inhalation agent concentration to maintain stable haemodynamics post-pneumoperitoneum were signicantly low(P=0.036) in group-1 as compared to group-3. Immediate bolus dose requirement of fentanyl after extubationwas signicantly low, and the duration of post-operative analgesia was prolonged(P=0.009) in group-1.Conclusion: Intrathecal dexmedetomidine may be a safe and effective method in alleviating haemodynamic stress response during pneumo-peritoneum and provides adequate post-operative analgesia in laparoscopic cholecystectomy.

A comparison of dexmedetomidine and clonidine premedication in perioperative hemodynamic stability and postoperative analgesia in laparoscopic cholecystectomy

The aim of this study was to compare dexmedetomidine and clonidine premedication in perioperative hemodynamic stability and postoperative analgesia in laparoscopic cholecystectomy.An observational study was conducted in Sir Sunderlal hospital, Banaras Hindu University. The study included ASA I-II patients undergoing laparoscopic cholecystectomy surgery. Patients undergoing general anaesthesia were included in the study. The control group received iv fentanyl, while patients in one experimental group received iv clonidine 1mcg/kg over 15 minutes, 30 minutes before and in another group received iv dexmedetomidine 1mcg/kg over 15 minutes, 30 minutes before the surgery. Heart Rate, SBP, MAP, DBP, ETCO, PCO and Post-Operative Analgesia were compared for the 3 groups. Results were given as mean ± SD. Data collected were analysed using Student’s t-test. Differences were considered statistically significant if P values were <0.05.A total of 90 patients were included and 30 patients each were randomly assigned to one of the 3 groups. Patients who received dexmedetomidine had better haemodynamic control and post-operative analgesia. Patients who received clonidine had better haemodynamic control than control group but not better than the group who received dexmedetomidine.We conclude that Alpha 2 agonists specially dexmedetomidine produce diverse responses including analgesia, anxiolysis, sedation and sympatholysis.

Bilateral Erector Spinae Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Erector spinae plane (ESP) block is a novel regional anesthetic technique. Its application for postoperative analgesia has been increasing since 2016; however, its effectiveness remains uncertain and varies according to the type of surgery. This meta-analysis aimed to assess the analgesic efficacy of ESP block in patients undergoing laparoscopic cholecystectomy. Literature searches of electronic databases and manual searches up to June 1, 2020 were performed. Review Manager Version 5.3 was used for pooled estimates. We included only randomized controlled trials (RCTs) in this meta-analysis. The random-effects meta-analysis model was used, and metaregression was applied when appropriate. A total of five RCTs consisting of 250 patients were included (124 in the ESP block group vs. 126 in the control group). Bilateral ESP block showed a significant reduction in postoperative intravenous opioid consumption reported up to 24hours after surgery (mean difference [MD]=-4.46, 95% confidence interval [CI] [-5.50 to -3.42], P<0.001) and in the time to first rescue analgesic (MD=73.27minutes, 95% CI [50.39 to 96.15], P<0.001). According to the results of four studies, the postoperative pain score was lower in the ESP group compared with the control group at both rest and movement. There were no differences between the two groups as concerns nausea (odds ratio [OR]=0.45, 95% CI [0.13 to 1.52], P=0.20) and vomiting (OR=0.37, 95% CI [0.10 to 1.35], P=0.13). No block-related complications were noted. This meta-analysis showed that bilateral ultrasound-guided ESP block could be considered as an effective option to reduce opioid consumption and the time to first rescue analgesic and seems to be also a safe technique in adults undergoing laparoscopic cholecystectomy.

Evaluation of efficacy of ultrasound guided erector spinae plane block and oblique subcostal transversus abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy

Aim & Objective: Laparoscopic cholecystectomy (LC) is a commonly performed minimally invasive surgery. LC can cause moderate to severe postoperative pain due to small keyhole entries on the abdominal wall. The oblique subcostal transversus abdominis plane block (OSTAP) has been used for postoperative analgesia after LC but found not so effective. Our aim is to compare the effectiveness of erector spinae block with OSTAP block for postop analgesia after LC. Materials and Methods: This prospective, randomized study was conducted at a tertiary care hospital. Seventy patients, 18 to 65 years old posted for LC were divided into two equal groups of 35 each. Erector spinae plane block was performed in the ESP group and oblique subcostal transverses abdominis plane block was performed in the OSTAP group. Postoperative rescue analgesic consumption, time to 1st rescue analgesia, numerical rating score (NRS), and any complications in 1st 24 hrs between the groups were compared. Results: Postoperative rescue analgesic (paracetamol) consumption was 1.9+ 0.85gm in ESP group and 2.84 + 0.29gm in OSTAP group which was statistically significant. Time to 1st rescue analgesia request was 360.34+28.94 mins in ESP group and 280.51+ 45.66 mins in OSTAP group which was statistically significant. Although NRS scores at almost all time-points were lower in the ESP group compared to OSTAP block, the difference was significant in 1st 6 hrs. Conclusion: Ultrasound guided ESP block reduced postoperative rescue analgesic consumption and pain scores more effectively than OSTAP block after laparoscopic cholecystectomy surgery. Keywords: Cholecystectomy, Laparoscopic, Pain management, Erector spinae plane block, Oblique subcostal transversus abdominis plane block.

Comparative Study of Preclosure Periportal Instillation of Three Different Concentrations of Ropivacaine (0.125%, 0.25%, 0.5%) for Postoperative Analgesia in Laparoscopic Cholecystectomy

Comparative Study of Preclosure Periportal Instillation of Three Different Concentrations of Ropivacaine (0.125%, 0.25%, 0.5%) for Postoperative Analgesia in Laparoscopic Cholecystectomy

Ultrasound-guided Bilateral Erector Spinae Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy: A Randomized Controlled Trial.

Background:Laparoscopic cholecystectomy (LC) is associated with moderate-to-severe pain in immediate postoperative period. Some patients even suffer from prolonged pain long after surgery.Aims:The aim of present study is to determine the efficacy of ultrasound-guided bilateral erector spinae plane block (ESPB) in patients undergoing LC, time to ambulation after surgery, and incidence of prolonged pain up to 6 months later.Settings and Design:This was a double-blinded prospective randomized controlled trial.Materials and Methods:Eighty-five adults posted for elective LC were randomized to receive bilateral ESPB at T7 level with either 20 mL of 0.375% ropivacaine or 20 mL normal saline. Postoperative static and dynamic pain score as per the visual analog scale (VAS), intraoperative requirement of fentanyl, postoperative use of diclofenac, time to ambulation after surgery, and presence of any pain after surgery were noted.Statistical Analysis:Independent t-test and Mann–Whitney U-test were used for quantitative data, while Chi-square test was used for comparing qualitative data.Results:Static and dynamic VAS scores were significantly lower in ESPB group (P < 0.05). Intraoperative fentanyl requirement (165 ± 30.72 – ESPB, 180.95 ± 29.12 – controls, P = 0.020) and number of patients requiring diclofenac (28/42 – ESPB, 37/42 – controls, P = 0.019) were lower, while number of patients ambulating by 4 hours (20/42 – ESPB, 9/42 – control, P = 0.012) were higher in ESPB group. Patients suffering from pain at 1 week (22/42 – ESPB and 34/42 – control, P = 0.005) and 1 month (9/42 – ESPB and 13/42 – control, P = 0.207) were lower in ESPB group.Conclusion:ESPB provides effective analgesia and early ambulation after LC. The benefit extends to 1 week thereafter.

Laparoskopik Kolesistektomide Postoperatif Ağrı için Ultrason Rehberliğinde Erektor Spina Plan Bloğun Etkinliği. Retrospektif Kohort Çalışma

Laparoskopik Kolesistektomide Postoperatif Ağrı için Ultrason Rehberliğinde Erektor Spina Plan Bloğun Etkinliği. Retrospektif Kohort Çalışma

The effect of intraoperative lidocaine versus esmolol infusion on postoperative analgesia in laparoscopic cholecystectomy: a randomized clinical trial

BackgroundAs a part of multimodal analgesia for laparoscopic cholecystectomy, both intraoperative lidocaine and esmolol facilitate postoperative analgesia. Our objective was to compare these two emerging strategies that challenge the use of intraoperative opioids. We aimed to assess if intraoperative esmolol infusion is not inferior to lidocaine infusion for opioid consumption after laparoscopic cholecystectomy.MethodsIn this prospective, randomized, double-blind, non-inferiority clinical trial, 90 female patients scheduled for elective laparoscopic cholecystectomy received either intravenous (IV) lidocaine bolus 1.5 mg/kg at induction followed by an infusion (1.5 mg/ kg/h) or IV bolus of esmolol 0.5 mg/kg at induction followed by an infusion (5–15 μg/kg/min) till the end of surgery. Remaining aspect of anesthesia followed a standard protocol apart from no intraoperative opioid supplementation. Postoperatively, patients received either morphine or tramadol IV to maintain visual analogue scale (VAS) scores ≤3. The primary outcome was opioid consumption (in morphine equivalents) during the first 24 postoperative hours. Pain and sedation scores, time to first perception of pain and void, and occurrence of nausea/vomiting were secondary outcomes measured up to 24 h postoperatively.ResultsTwo patients in each group were excluded from the analysis. The postoperative median (IQR) morphine equivalent consumption in patients receiving esmolol was 1 (0–1.5) mg compared to 1.5 (1–2) mg in lidocaine group (p = 0.27). The median pain scores at various time points were similar between the two groups (p > 0.05). More patients receiving lidocaine were sedated in the post-anesthesia care unit (PACU) than those receiving esmolol (p < 0.05); however, no difference was detected later.ConclusionInfusion of esmolol is not inferior to lidocaine in terms of opioid requirement and pain severity in the first 24 h after surgery. Patients receiving lidocaine were more sedated during their stay in PACU than those receiving esmolol.Trial registrationClinicalTrials.gov- NCT02327923. Date of registration: December 31, 2014.

Effect of Preoperative Ketamine and Magnesium Sulfate on Intra &amp; Postoperative Analgesia in Laparoscopic Cholecystectomy: A Comparative Randomized Controlled Study

Effect of Preoperative Ketamine and Magnesium Sulfate on Intra &amp; Postoperative Analgesia in Laparoscopic Cholecystectomy: A Comparative Randomized Controlled Study

Comparative Evaluation of Effectiveness of Intravenous Paracetamol and Intravenous Diclofenac as Post-operative Analgesia in Laparoscopic Cholecystectomy

Introduction: Though the development of minimally invasive surgery has revolutionized the field of surgery, post-operative pain is still a significant issue. Unlike in the past, concerns about adverse effects have limited the role of opioids in post-operative pain management. This study aims to compare the effectiveness of intravenous paracetamol and diclofenac as postoperative analgesia in laparoscopic cholecystectomy.&#x0D; Methods:One hundred and twenty eight patients of American Society of Anesthesiologists (ASA) categories I and II included in this study were divided into two groups. Anesthesia induction and maintenance were standardized. The first group received 15mg/kg (maximum 1gm) intravenous paracetamol and the second group received 2mg/kg (maximum 75mg) intravenous diclofenac 30 minutes prior to ending of surgery. A questionnaire was responded by patients and chart was maintained by visual analogue scale. Mann Whitney U test was used to analyze quantitative data and Chi-square test for categorical data. P value &lt;0.05 was considered statistically significant.&#x0D; Results: Profiles of hemodynamic changes were almost similar in both groups with respect to heart rate and blood pressure. However, paracetamol infusion provided hemodynamic stability in post-operative period. We observed statistically significant differences in visual analogue scale between the two groups. Most of the patients in paracetamol group had low mean pain scores in post-operative period and provided an extended analgesia compared to diclofenac. No serious postoperative complication was observed in paracetamol group.&#x0D; &#x0D; Conclusion: Administration of intravenous paracetamol has better and prolonged analgesic effect with low mean pain score and less requirement for rescue analgesia compared to diclofenac.

Effect of Intraperitoneal Ketamine as Postoperative Analgesia in Laparoscopic Cholecystectomy

Background: Laparoscopic surgery is gaining popularity so different modalities of pain management should be used as patients experience postoperative pain of different sources especially from the abdomen, back and shoulder region which is severe especially in first postoperative hours. Objective: We aimed to evaluate effect of intraperitoneal instillation of ketamine and normal saline on post- operative pain and analgesic requirements after laparoscopic cholecystectomy. Patients and Methods: Forty patients undergoing laparoscopic cholecystectomy were randomly allocated and divided into two groups, The ketamine intraperitoneal (KIP) group (n=20 patients), in which 0.5 mg/kg ketamine diluted in 30 ml normal saline was instilled intraperitoneally,The saline intraperitoneal (SIP) group (n=20 patients), in which 30 ml of normal saline was instilled intraperitoneally. Patients receive these drugs as follow, 16 ml in gall bladder fossa while other 14 ml under copula of diaphragm on both sides while patients were placed in 15-20-degree trendelenburg position. This was done before patients recovered from anesthesia, then patients extubated and transferred to ward. Patients were evaluated according to VAS, time to first analgesic and total analgesic requirements during 24 hours post-operative. Results: Our results showed that usage of ketamine decreases postoperative pain and analgesic consumption in the first 24 hours after surgery along with longer pain free period compared to patients who were given bupivacaine after laparoscopic cholecystectomy. In our study ketamine 0.5mg/kg was safely used as we did not observe any sign of toxicity. Conclusion: Intraperitoneal instillation of local anesthetic is an easy, cheap and safe method which provides good analgesia in the immediate postoperative period after laparoscopic surgery. Ketamine is highly effective in postoperative pain control in laparoscopic cholecystectomy without any hazards on patients.

Evaluation of ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy: A prospective, randomized, controlled clinical trial

Study objectiveLaparoscopic cholecystectomy (LC) is a commonly performed minimally invasive procedure that has led to a decrease in procedure-related mortality and morbidity. However, LC requires analgesia that blocks both visceral and somatic nerve fibers. In this study, we evaluated the effectiveness of Erector Spinae Plane Block (ESPB) for postoperative analgesia management in LC. DesignSingle-blinded, prospective, randomized, efficiency study. SettingTertiary university hospital, postoperative recovery room & ward. Patients36 patients (ASA I-II) were recruited in two equal groups (block and control group). Following exclusion, 30 patients were included in final analysis. InterventionsStandard multimodal analgesia was performed in Group C (control) while ESPB block was also performed in Group B (block). MeasurementsPain intensity between groups were compared using Numeric Rating Scores (NRS). Also, tramadol consumption and additional rescue analgesic requirement were measured. Main resultsNRS was lower in Group B during the first 3 h. There was no difference in NRS scores at other hours. Tramadol consumption was lower in Group B during the first 12 h. Less rescue analgesia was required in Group. ConclusionBilateral ultrasound guided ESPB leads to effective analgesia and a decrease in analgesia requirement in first 12 h in patients undergoing LC.

Comparison of Posterior and Subcostal Ultrasound-Guided Transversus Abdominis Plane Block Approaches for Postoperative Analgesia in Laparoscopic Cholecystectomy

AbstractBackground: Pain after LC is complex and characterized by various components with different intensities and time courses. The establishment of LC as an outpatient procedure has accentuated the clinical importance of proper post-operative pain control.Aim: Our aim is to compare between US posterior and subcostal approaches TAP block for post-operative analgesia in LC.Material and Methods: This study was carried out on 60 patients, ASA I-II, scheduled for elective laproscopic chole-cystectomy under general anesthesia. Patients were randomized into three equal groups (20 patients in each group): Group I (control group): Received standard general anesthesia. GroupII (posterior TAP group): Received standard general anesthesia and bilateral US guided posterior TAP block with 15ml bupivacaine 0.25% on each side just before extubation. GroupIII (subcostal TAP group): Received standard general anesthesia and bilateral US guided subcostal TAP block with 15ml bupivacaine 0.25% on each side just before extubation. All groups received post-operative analgesia in the form of IV paracetamol 1gm every 6 hours and rescue analgesic in form of morphine 2mg IV. The following parameters were compared: Post-operative vital signs (HR & MAP), post-operative pain (using 10 point Visual Analogue Scale (VAS) where (0) no pain and (10) most intense pain), time for first post-operative required analgesia and 24-hour morphine consumption were measured in the 3 groups immediately after full recovery of anesthesia, 1h, 2h, 4h, 6h, 8h, 12hr & 24hr.Results: In our study the mean values of HR and MAP were lower in Group II and Group III than Group I & that of Group III were lower than that of Group II at all times after recovery. The mean values of pain assessment by VAS in Group II and Group III were lower than that of Group I at all times after recovery. The VAS in Group III were lower than that of Group II insignificantly immediately after recovery, 1h, 2h, 12h and 24 hours and significantly at 4h, 6h and 8 hours. Also the mean time to the first request of morphine, was longer in Groups II and III than in Group I. Group III was significantly longer than Group II. The total dose of post-operative morphine consumption in Group II and Group III were lower than that in Group I. There was significantly lower total dose of post-operative morphine consumption in Group III than Group II.Conclusion: Both the posterior and subcostal US TAP block provides superior analgesia than the standard IV regimen. However, beyond the initial 4 hours after recovery, patients in the subcostal TAP group had significantly lower pain scores than did patients from the other groups.

Effect of Dexmedetomidine on Intraoperative Haemodynamics and Postoperative Analgesia in Laparoscopic Cholecystectomy

Background and objectives:Dexmedetomidine is an α2 agonist with sympatholytic, anxiolytic, sedative and analgesic effect used as adjunct during surgeries for its haemodynamic stabilizing effect and analgesic effect. Primary aims of the study were to evaluate the haemodynamic effect of intravenous dexmedetomidine and the duration and quality of analgesia in laparoscopic cholecystectomy. Secondary aims were sedation levels and occurrence of side effects.Materials and methods:Eighty four patients, American society of Anaesthesiologists physical status I and II, aged 18-60 years of either gender undergoing laparoscopic cholecystectomy in general anaesthesia were randomly allocated into two equal groups. Group C patient received Normal Saline and Group S patient received dexmedetomidine loading dose infusion of 1µg/kg over 10 minutes before induction and maintained with 0.4µg/kg/hr till the removal of gall bladder. Induction with propofol and fentanyl was done. Standard monitoring including Heart Rate, Mean arterial pressure, oxygen saturation were monitored perioperatively. Postoperative analgesia requirement and sedation score were assessed.Results: In Group S, the haemodynamic responses were significantly attenuated. During postoperative period, 24 hours analgesic requirement of diclofenac sodium was 141.43mg in group S as compared to 217.50mg in group C(p&lt;0.001). Side effects were treatable. Sedation was better in Group S.Conclusion:Dexmedetomidine effectively attenuates haemodynamic stress response during laparoscopic surgery with reduction in postoperative analgesic requirements.

Effect of Perioperative Intravenous Lignocaine Infusion on Haemodynamic Responses and postoperative Analgesia in Laparoscopic Cholecystectomy Surgeries.

BackgroundDuring general anaesthesia, intubation of trachea and extubation of trachea are often associated with increase in haemodynamic response. Laparoscopic cholecystectomy is a minimal access surgery; postoperatively patients may experience moderate to severe pain. It is well known that lignocaine is useful in attenuating haemodynamic response to intubation and extubation. Previous studies also state that perioperative lignocaine infusion provides postoperative analgesia as well. We hypothesize that perioperative intravenous lignocaine infusion can both attenuate haemodynamic responses to intubation and extubation of trachea and also provide good postoperative analgesia in laparoscopic cholecystectomy surgeries.MethodsDouble blinded randomized controlled trial was undertaken at the department of anesthesia, Sri Siddartha medical college. In group A, 0.9% normal saline was used as placebo for perioperative intravenous infusion. In group B, preservative free 1.5 mg/kg 2 % lignocaine (Loxicard) diluted with normal saline to 1% given at 10 minutes to induction as bolus, followed by an infusion of 1.5 mg/kg/h. till 1 hour postoperatively.ResultsIn Group B there was a statistically less rise in heart rate [HR] and mean blood pressure [MBP] during intubation and extubation of trachea compared to group A. In group B there was a statistically significant increase in the mean pain free period postoperatively compared to group A.ConclusionsPerioperative intravenous infusion of lignocaine attenuates haemodynamic response during the intubation and extubation of the trachea. In addition, it also increases the mean pain free period postoperatively.

Comparative clinical study of gabapentin and pregabalin for postoperative analgesia in laparoscopic cholecystectomy.

Background:Reduction in central sensitization by gabapentinoids that include gabapentin and pregabalin may reduce acute postoperative pain.Aims:The aim of this study is to evaluate postoperative analgesic benefit and efficacy in patients administered with oral gabapentin or pregabalin as premedication for laparoscopic cholecystectomy under general anesthesia.Settings and Design:Randomized, prospective, and comparative study.Materials and Methods:In this study, recruited patients were randomly allocated in three groups. Groups A, B, and C received 2 capsules of B complex, 3 capsules of 300 mg gabapentin each, and 2 capsules of 75 mg pregabalin, respectively, each in 30 patients of each group, 1 h before induction of anesthesia. Postoperative efficacy among these three groups was compared with respect to increase in duration of analgesia, reduction in postoperative pain scores, total postoperative requirements of analgesics and side effects.Statistical Analysis:Mean and standard deviation were calculated. Test of analysis between two groups was done by t-test and among three groups by analysis of variance, and then P value was calculated.Results:Pregabalin and gabapentin group had lower visual analog scale (VAS) score (P < 0.05), prolonged timing of first rescue analgesic (4.67 ± 14.79 vs. 158 ± 13.10 vs. 343.16 ± 9.69) min, and less opioid consumption (169.87 ± 20.32 vs. 116.13 ± 14.08 vs. 64.67 ± 16.69) mg compared to placebo group. Between the gabapentinoids, pregabalin group had lower VAS score, prolonged timing of first rescue analgesic, and less opioids consumption than the gabapentin group.Conclusion:It is concluded in this study that pregabalin group had lower VAS score, prolonged timing of first rescue analgesic, and less opioids consumption than the gabapentin group. Both gabapentinoids had better postoperative analgesic profile than placebo.

Comparative evaluation of efficacy of intravenous paracetamol and intravenous diclofenac as post-operative analgesia in laparoscopic cholecystectomy

Background: Though laparoscopic cholecystectomy is a minimal invasive surgery but inadequate pain management interferes with early discharge of patient. Administration of opioid for pain relief is a concern because of its side effects. To avoid this problem, we planned our study to find out the best alternative of opioid in patients undergoing laparoscopic cholecystectomy. Methods: 68 patients were enrolled for this study in a stipulated time of 1 year in a tertiary level hospital. A questionnaire was responded by patients and a chart was maintained for pain score in visual analogue scale (VAS) and for side effects. We used paracetamol and diclofenac as post operative analgesic in two different groups and data was recorded in Excel panel and was analyzed by standard statistical test by software MINITAB 1513 with a significant p- value of <0.05. Results: We have found the significant outcome (p-values are 0.0005 at 0 hrs, 0.003 at 2 hrs, 0.001 at 6 hrs, 0.0005 at 12 hrs) in VAS pain score in between the two groups at different intervals. Patients who were administered paracetamol had shown better outcome with less requirement of rescue analgesia and side effects. Conclusion: Administration of intravenous paracetamol in the intra operative period 30 minutes prior to the completion of surgery followed by administration of 1g paracetamol every 8 hourly in the post-operative period gives better quality of analgesia.

Comparison of Posterior and Subcostal Approaches to Ultrasound-Guided Transversus Abdominis Plane Block for Postoperative Analgesia in Laparoscopic Cholecystectomy

*Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh; and †Department of Anaesthesia, Fortis Hospital, Punjab, India.

Comparison of posterior and subcostal approaches to ultrasound-guided transverse abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy

Study ObjectiveTo evaluate the effectiveness of subcostal TAP block and to compare its efficacy with that of posterior TAP block in decreasing postoperative pain in patients undergoing laparoscopic cholecystectomy during general anesthesia. DesignProspective, randomized, double-blind study. SettingAcademic medical center. Patients60 adult, ASA physical status 1 and 2 patients of both genders, aged 18-60 years, scheduled for elective laparoscopic cholecystectomy. InterventionsPatients were randomized to three groups of 20 patients each. Group 1 patients received standard general anesthesia (control group); Group 2 patients received an ultrasound-guided posterior TAP block using 15 mL of 0.375% ropivacaine on each side; and Group 3 patients underwent a subcostal TAP block with 15 mL of 0.375% ropivacaine on each side. MeasurementsThe presence and severity of pain during rest and movement, as well as nausea or vomiting and sedation, were assessed in all patients postoperatively on PACU admission, then at 2, 4, 6, 8, 12, and 24-hour intervals. Patients with a visual analog score (VAS) greater than 4, or those requesting analgesic were given intravenous tramadol 2 mg/kg as an initial dose; subsequent 1 mg/kg doses of tramadol, if needed, were given. ResultsPatients who received a subcostal TAP block had significantly lower pain scores at rest and on movement than the control group at all times postoperatively. Although, in the initial postoperative measurement times, the subcostal and posterior TAP groups had comparable pain scores, after 4 hours these scores were significantly lower in patients who had received the subcostal TAP block. ConclusionFor incisions mainly involving the supra-umbilical region, subcostal TAP block may be a better alternative than the posterior approach for providing postoperative analgesia.

Comparison postoperative analgesia between fentanyl and tramadol in laparoscopic cholecystectomy

Objective To observe the effects of intravenous injection of fentanyl and tramadol on postoperative analgesia in laparoscopic cholecystectomy of clinical efficacy.Methods 80 cases treated with laparoscopic cholecystectomy were randomly divided into the fentanyl group (group F) and tramadol group (group Q).VAS score,adverse reaction incidence and patient satisfaction,were observed after the administration of 0.5,1,2,4,8,12h.Results In group F after administration of 0.5,1,2h,VAS score was better than that of group Q; group F after administration of the drug 4,8 h VAS score was inferior to group Q;two groups of patients in postoperative 12h VAS scores showed no significant difference in group F;the overall incidence of adverse reactions was higher than that of group Q,patients' satisfaction was higher than that of group Q.Conclusion Intravenous fentanyl in laparoscopic cholecystectomy operation postoperative overall are superior to the analgesic effect of tramadol,with high patient's satisfaction. Key words: Analgesia; Cholecystectomy, laparoscopic ; Fentanyl; Tramadol